The recovery status from delayed graft function can predict long-term outcome after deceased donor kidney transplantation

Abstract

The effect of delayed graft function (DGF) recovery on long-term graft outcome is unclear. The aim of this study was to examine the association of DGF recovery status with long-term outcome. We analyzed 385 recipients who underwent single kidney transplantation from brain-dead donors between 2004 and 2015. Patients were grouped according to renal function at 1 month post-transplantation: control (without DGF); recovered DGF (glomerular filtration rate [GFR] ≥ 30 mL/min/1.73 m2); and incompletely recovered DGF group (GFR < 30 mL/min/1.73 m2). DGF occurred in 104 of 385 (27%) recipients. Of the DGF patients, 70 recovered from DGF and 34 incompletely recovered from DGF. Death-censored graft survival rates for control, recovered DGF, and incompletely recovered DGF groups were 95.3%, 94.7%, and 80.7%, respectively, at 5 years post-transplantation (P = 0.003). Incompletely recovered DGF was an independent risk factor for death-censored graft loss (HR = 3.410, 95%CI, 1.114-10.437). DGF was associated with increased risk for patient death regardless of DGF recovery status. Mean GFRs at 5 years were 65.5 ± 20.8, 62.2 ± 27.0, and 45.8 ± 15.4 mL/min/1.73 m2 for control, recovered, and incompletely recovered DGF groups, respectively (P < 0.001). Control group and recovered DGF patients had similar renal outcomes. However, DGF was associated with increased risk for patient death regardless of DGF recovery status.

Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants

“…Contrariwise, those with uncomplete recovery presented lower survival and lower GFR at five years after transplantation. 23…”

Increased soluble fms-like tyrosine kinase 1 after ischemia reperfusion contributes to adverse clinical outcomes following kidney transplantation

“…Several studies have reported that DGF alone can influence long-term outcomes, including decreased graft and patient survival. [21][22][23] Although acute tubular necrosis is the most frequent cause of DGF, endothelial injury and microvascular dysfunction also play an important role in DGF pathogenesis. 6 Elevation in sFlt-1 levels simultaneously with DGF occurrence may argue for a short-term effect of sFlt-1 on the microvascular endothelium, resulting in acute hemodynamic changes, 24,25 followed by a long-term impairment in endothelial repair and subsequent vessel dropout.…”

Assessment of Organ Quality in Kidney Transplantation by Molecular Analysis and Why It May Not Have Been Achieved, Yet

“…Hence, not DGF per se but rather ability to recover from DGF as indicated, e.g., by GFR at 1 month might be a more reliable marker of long-term graft outcome and quality, as recently reported by Lee et al (76). Donor age, donor final creatinine and cold ischemia time were significantly associated with DGF recovery status (76).…”